Provider Demographics
NPI:1558415885
Name:MENISH, JODIE ROYAL (LCSW)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:ROYAL
Last Name:MENISH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:ROYAL
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:GIRDWOOD
Mailing Address - State:AK
Mailing Address - Zip Code:99587-1132
Mailing Address - Country:US
Mailing Address - Phone:502-494-8249
Mailing Address - Fax:
Practice Address - Street 1:1345 W 9TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3236
Practice Address - Country:US
Practice Address - Phone:907-791-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0984901Medicare PIN